This multidisciplinary textbook presents a unique approach to diagnosis and management of the various temporomandibular disorders. Written by a large group of eminent researchers and clinicians, it links current scientific concepts of basic anatomy, physiology, biomechanics, and pathology of the temporomandibular joint with specific diagnostic and treatment protocols that are based on sound clinical data. Thus, in keeping with the current thrust in medicine and dentistry, the book provides access to the best available evidence so that clinicians can make informed rather than empirical decisions about what is appropriate therapy. Where lack of data or rapid changes in a particular discipline do not allow for evidence-based conclusions or recommendations, the book highlights the areas of agreement and disagreement in order to expose the deficiencies in our present knowledge base. In a field of treatment long associated with controversy, this book educates readers about which current practices of diagnosis and treatment are strongly supported by scientific research and which are supported only by practical experience and/or anecdotal evidence.

560 pp; 435 illus; (119 in color);

ISBN 0-86715-447-0; 0867154470;
978-0-86715-447-4; 9780867154474;

Contents
Part I: Biologic Basis
Section A: Anatomy and Function
1. Functional Anatomy and Biomechanics of the Masticatory Apparatus—William L. Hylander
2. Anatomy and Function of the TMJ—Ales Obrez & Luigi M. Gallo
3. TMJ Growth, Adaptive Modeling and Remodeling, and Compensatory Mechanisms—Boudewijn Stegenga & Lambert G.M. de Bont
4. Sensory and Motor Neurophysiology of the TMJ—Barry J. Sessle

Section B: Pathophysiology of the TMDs
5. Persistent Orofacial Pain—Ronald Dubner & Ke Ren
6. Muscular Pain and Dysfunction—James P. Lund
7. TMJ Osteoarthritis—Stephen B. Milam
8. TMJ Disc Derangements—Boudewijn Stegenga & Lambert G.M. de Bont
9. Systemic Conditions Affecting the TMJ—Mauno Kononen & Bengt Wenneberg

Part II: Clinical Management
Section A: Diagnostic Modalities
10. TMJ Imaging—Tore A. Larheim & Per-Lennart Westesson
11. Analysis of TMJ Synovial Fluid —Regina Landesberg & Linda L. Huang
12. The Role of Technology in TMD Diagnosis—Charles S. Greene
13. Psychological and Psychosocial Assessment—Samuel F. Dworkin

Section B: Diagnosis
14. Concepts of TMD Etiology: Effects on Diagnosis and Treatment—Chales S. Greene
15. TMJ Arthritis—A. Omar Abubaker
16. Internal Derangements—Daniel M. Laskin
17. Masticatory Muscle Pain and Dysfunction—Yoly M. Gonzalez & Norman D. Mohl
18. Traumatic Injuries—Dean A. Kolbinson & Frank I. Hohn
19. Maxillofacial Movement Disorders—Leon A. Assael
20. Differential Diagnosis of Orofacial Pain—Robert L. Merrill
21. Benign and Malignant Tumors—Diane Stern
22. Fibromyalgia—Octavia Plesh & Stuart A. Gansky

Section C: Therapeutic Modalities
23. Pharmacologic Approaches—Raymond A. Dionne
24. Physical Medicine—Jocelyne S. Feine and J. Mark Thomason
25. Oral Appliances—Glenn T. Clark & Hajime Minakuchi
26. Biobehavioral Therapy—Richard Ohrbach
27. Management of Dental Occlusion—Christian S. Stohler
28. Indications and Limitations of TMJ Surgery—Daniel M. Laskin

Section D: Evidence-Based Treatment
29. Congenital and Developmental Anomalies—Maria J. Troulis & Leonard B. Kaban
30. Medical Management of TMJ Arthritis—Sigvard Kopp
31. Surgical Management of TMJ Arthritis—Louis G. Mercuri
32. Surgical Management of Internal Derangements—Daniel M. Laskin
33. Treatment of Myogenous Pain and Dysfunction—Glenn T. Clark
34. Treatment of Maxillofacial Movement Disorders—Leon A. Assael
35. Surgical Management of Benign and Malignant Neoplasms—Lewis Clayman
36. Management of Idiopathic Condylar Resorption—M. Anthony Pogrel & Radhika Chigurupati

Preface

This book continues the tradition established more than 50 years ago with the publication of Dr Bernard G. Sarnat’s monograph on the TMJ (The Temporomandibular Joint, Thomas, 1951). That volume was based on a series of symposia and lectures held at the University of Illinois College of Dentistry in Chicago involving some of the pioneers in the field. It was the first to deal comprehensively with this emerging field, clarifying some of the existing controversies, but it was relatively brief because of the limited information available at that time. Subsequently, three more extensive editions were published in 1964, 1980, and 1992, with the last two co-edited by the senior editor of this book (DML). The basic premise of all four editions was to integrate the expertise of multiple basic scientists and clinicians in order to address the biologic complexity of the temporomandibular system as well as the clinical challenges of diagnosis and treatment.

In this new book we have maintained that collaborative process but have made significant changes in the organization and manner of presentation of the latest information. As in the past, many of the most eminent researchers and clinicians in the world were invited to summarize the current status of their particular field of expertise. In keeping with the current thrust in both medicine and dentistry, these authors were asked to use evidence-based knowledge rather than opinion as the fundamental standard for arriving at the conclusions and recommendations in their particular chapter. However, when this was not possible because of a lack of supporting data or rapid changes in the field, they were asked to highlight the areas of agreement and disagreement within their discipline. As a result, the reader can see where there are deficiencies in our present knowledge base, which in itself is valuable information. More importantly, however, the reader can see which current practices of diagnosis and treatment are strongly supported by scientific research and which are supported only by practical experience and/or anecdotal evidence.

Although once again divided into two parts, the first addressing the biologic basis of TMDs and the second covering clinical management of these disorders, this book features an otherwise unique and innovative organization. The two sections in the first part of the book separate normal TMJ anatomy and function from the various pathologies, injuries, and dysfunctional conditions that can affect the TMJ complex. In the second part, a section on diagnostic modalities in current use with a critical review of the evidence supporting their sensitivity, specificity, and clinical value precedes the section on the diagnosis of specific clinical conditions. Likewise, chapters on the various therapeutic modalities that have been recommended in the literature, with each method subjected to critical scrutiny, precede the section on specific treatment protocols. This final section emphasizes the actual clinical management of patients with various TMDs based on the combination of scientific and clinical information discussed in the earlier sections.

The challenge for editors of a book with multiple authors is to weave all the parts together into a whole cloth. With 42 authors writing 36 chapters, we did not expect this to be easy, nor did we expect unanimity of opinion on every subject. Readers will certainly notice some different viewpoints among the authors as they read this book, which reflects the current reality of this complex and often controversial field. The pace of new developments in certain aspects of TMD-related pain has been so fast that, to keep the book current, some chapters were being modified up to the final publication deadline. This was especially true in such areas as the pathophysiology of myofascial pain and osteoarthritis, sensory and motor neurophysiology, fibromyalgia, and pharmacologic approaches to patient management. In addition, recent advances in the biobehavioral dimensions of diagnosing TMDs, as well as managing them, have significantly changed the current landscape for understanding these patients—especially those with chronic pain conditions.

Another difficulty in having multiple authors writing about a complex subject such as TMDs is to maintain consistency in terminology. For example, in the United States degenerative joint disease is usually referred to as osteoarthritis, whereas in Europe it is termed osteoarthrosis. In this text we have chosen to use the former designation. The term condyle is also often used when condylar process is meant. The latter consists of both the condyle (the uppermost part, also referred to as the condylar head) and a condylar neck. An even more difficult situation is found in the use of the term temporomandibular disorder (TMD). When used correctly, it is a singular term referring to a particular arthrogenous or myogenous condition, and therefore it requires a modifying term in order to be specific (eg, a patient has a myofascial TMD). However, in the dental literature authors often use TMD as an all-inclusive label so that it is impossible to determine which conditions are being included (eg, TMD is a biopsychosocial condition). To avoid such confusion, we have used the term TMD with a modifier when referring to a specific disorder and TMDs when a group of conditions is being discussed.

In an area with so much misinformation and confusion, it is a significant challenge to put aside personal bias and opinion and base one’s conclusions only on what has been substantiated in the scientific literature. The contributors to this book are to be congratulated for accepting this challenge and fulfilling it most admirably. In doing so, they have not only lent clarity to the subject of TMDs but also made a significant contribution to improved patient care.

Edited by Daniel M. Laskin, Charles S. Greene, and William L. Hylander

Reviews

“There are quite a few textbooks about orofacial pain and TMDs on the market. Do we really need another one? In my opinion the answer is definitely yes! This book will be of value for orofacial pain clinicians, orofacial specialist training, and anyone interested in the current knowledge about TMDs.”
Malin Ernberg, DDS, PhD
Journal of Orofacial Pain Winter 2008